By Liz Rosenthal on SwimSwam
As high school swimming in Florida approaches the heart of its season, swimmers are all in, focusing on dropping time and aiming to advance to the state series in November. But before they even dove in this fall, some athletes had one additional box to check: an electrocardiogram (ECG), also widely known as an EKG.
This school year, a new state law called the Second Chance Act established an ECG requirement for incoming ninth graders and students in grades 10-12 who have never participated in an FHSAA-sanctioned sport. The goal is to identify previously undetected cardiac risk factors in young athletes. Details of the law and FHSAA guidance can be found here: Florida’s Second Chance Act (SB 1070) and FHSAA guidance.
The legislation was inspired by the September 2024 death of 18-year-old Chance Gainer, a football player at Port St. Joe High School who collapsed during a game and later died from a previously undiagnosed heart condition. Named in his memory, the Second Chance Act was signed into law in June 2025, with the ECG requirement taking effect for the 2026–27 school year.
The new requirement has brought cardiac screening into the conversation among Florida high school athletes and their families.
Daniel Aldea, MD, assistant professor of medicine and director of sports cardiology at Washington University School of Medicine in St. Louis, explained both the value and the limitations of ECG screening for young athletes.
“The main idea of a sports ECG is to identify some of the common conditions that cause sudden cardiac death in athletes,” Dr. Aldea said. However, an ECG cannot detect every potential problem, and a normal result does not eliminate every risk. Nor does an abnormal ECG automatically mean an athlete has a serious heart condition or cannot participate in sports.
“Most of the time an abnormal test does not indicate that there is a severe diagnosis, but does warrant further evaluation,” Dr. Aldea said. Depending on the findings, additional testing may be needed to determine what the result means for the athlete’s heart.
Interpreting results in context is also important, he explained. Because athletic conditioning can affect ECG findings, results should be interpreted by someone specifically familiar with athletes. Additionally, he advises, a thorough medical history, including family history, and a sports physical remain important parts of cardiac screening because some conditions may not be apparent on an ECG.
For Florida families, getting the screening done was one more thing to navigate in an already busy sports season. Between coordinating calendars, purchasing uniforms, filling out forms and scheduling appointments, adding another task to the list could be a challenge.
Cost and access were also part of the equation. How families completed the screening depended in part on the options available to them.
Some families went through their own pediatricians and health insurance, while others used free or low-cost screenings offered at school or through local hospitals and other organizations. The Florida law directs school districts to pursue public and private partnerships to provide ECGs for less than $50 per student. Nonprofit organizations such as Who We Play For work with schools and communities to help bring ECG screenings to young athletes. The statute outlines the cost provision and other requirements.
For one freshman swimmer, Zoe, her mother said arranging the appointment was easy. Her pediatrician even offered free alternatives in case a school screening wasn’t available.
For Cyrus, another high school swimmer, a free ECG offered through his school led to further testing after it revealed a low heart rate. His parents, Chelsea and Isaac, said they were told his low heart rate was likely related to his swimming. The family followed up at Nicklaus Children’s Hospital, where Cyrus underwent further evaluation and was cleared to compete.
His parents feel reassured by the process. “We feel it should be for all children. It’s preventative, non-invasive and quick,” they said. “Our family is glad we did it and know he has a healthy heart.”
Dr. Aldea emphasized that while ECG screening can help identify some cardiac conditions, it cannot prevent every sudden cardiac event. “Even with the best testing, it is impossible to catch every cause,” he said.
Dr. Aldea noted that sudden cardiac events in young athletes are very rare, but can be devastating when they occur. He stressed that preparedness is critical, too.
“By far, the most important factor of someone surviving a cardiac arrest is having coaches, parents, and staff be trained in CPR, having access to an automated external defibrillator (AED),” he said.
He advised that parents can ask whether AEDs are available at the places where their children practice and compete, whether coaches and staff are trained in CPR, and whether the facility has an emergency action plan that includes coordination with local hospitals.
Championship season is here, and so is the Second Chance Act.
Florida’s swimmers dove in first.
Winter sports athletes, you’re on deck!
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